Cost-effectiveness of additional catheter-directed thrombolysis for deep vein thrombosis

Abstract

Summary Background Additional treatment with catheter-directed thrombolysis (CDT) has recently been shown to reduce post-thrombotic syndrome (PTS). Objectives To estimate the cost effectiveness of additional CDT compared with standard treatment alone. Methods Using a Markov decision model, we compared the two treatment strategies in patients with a high proximal deep vein thrombosis (DVT) and a low risk of bleeding. The model captured the development of PTS, recurrent venous thromboembolism and treatment-related adverse events within a lifetime horizon and the perspective of a third-party payer. Uncertainty was assessed with one-way and probabilistic sensitivity analyzes. Model inputs from the CaVenT study included PTS development, major bleeding from CDT and utilities for post DVT states including PTS. The remaining clinical inputs were obtained from the literature. Costs obtained from the CaVenT study, hospital accounts and the literature are expressed in US dollars ($); effects in quality adjusted life years (QALY). Results In base case analyzes, additional CDT accumulated 32.31 QALYs compared with 31.68 QALYs after standard treatment alone. Direct medical costs were $64 709 for additional CDT and $51 866 for standard treatment. The incremental cost-effectiveness ratio (ICER) was $20 429/QALY gained. One-way sensitivity analysis showed model sensitivity to the clinical efficacy of both strategies, but the ICER remained < $55 000/QALY over the full range of all parameters. The probability that CDT is cost effective was 82% at a willingness to pay threshold of $50 000/QALY gained. Conclusions Additional CDT is likely to be a cost-effective alternative to the standard treatment for patients with a high proximal DVT and a low risk of bleeding.

Health-related quality of life after catheter-directed thrombolysis for deep vein thrombosis: secondary outcomes of the randomised, non-blinded, parallel-group CaVenT study

“…The VEINES-QOL/Sym comprises 26 items regarding problems of the lower limbs 4. The instrument measures symptoms, limitations in daily activity and psychological impact during the previous 4 weeks and change over the past year.…”

“…PTS is characterised by persistent pain, heaviness, swelling and deterioration of the skin. Previously, in the CaVenT study, we have shown that additional catheter-directed thrombolysis (CDT) in patients with a high proximal DVT localised in the mid-thigh level or above, and a low risk of bleeding, reduced the frequency of PTS from 56% to 41% (p=0.047) after 2 years and that CDT is likely to be a cost-effective alternative to standard treatment 4 5. However, as PTS is a chronic condition associated with substantial morbidity and with no healing treatment options, assessment of both generic and disease-specific health-related quality of life (QOL), including the impact on health and daily functioning, may provide meaningful information not captured by clinical scores and other traditional health outcome measures.…”

Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis

“…16 Clinical trials to date [16][17][18][19][20] have revealed low adverse event rates but were underpowered to detect significant differences in in-hospital adverse events, including bleeding complications, between treatment groups. The benefits achieved with CDT through a reduction in the rates of postthrombotic syndrome [19][20][21] should be evaluated in the context of an increase in bleeding-related complications. This is reflected in current societal recommendations, with the American Heart Association recommending CDT as first-line therapy for patients with low bleeding risk, 22 good functional capacity, and life expectancy of >1 year.…”

Symptom burden and job absenteeism after treatment with additional catheter-directed thrombolysis for deep vein thrombosis

“…PTS symptoms include persistent swelling, pain, and discomfort that is typically most pronounced at the end of the day and is aggravated by standing and walking. Despite a small risk of bleeding, additional CDT is likely to represent a cost-effective treatment alternative and should be considered in patients with no apparent risk of bleeding 5. The rationale for introducing thrombolytic treatment for acute DVT was the “open vein hypothesis,” which suggested that accelerated resolution of the clot using a thrombolytic agent restores venous function by reducing the two most likely pathophysiologic factors contributing to PTS: persistent lumen obstruction and incompetent venous valves.…”